March 07, 2014

Pharmaceutical Companies Drastically Cut Speaker Payments for Doctors

A number of large pharmaceutical companies have greatly reduced payments to healthcare professionals for promotional speeches. ProPublica reports that GlaxoSmithKline and Pfizer have dropped their speaking payments by over 60% from 2011 to 2012. Eli Lilly reduced their spending by 55%, from $47.9 million in 2011 to $21.6 million in 2012. During the same period, Novartis reduced their spending from $24.8 million to $14.8 million.

ProPublica states that the sharp drop in payments coincides with the large settlement figures pharmaceutical companies have forked over to the government for their marketing practices, including off-label promotion and allegations of kickbacks to doctors. The website also notes that the mandatory disclosures of the Physician Payments Sunshine Act are likely spurring the change.

Members of industry argue that the numbers reflect their marketing needs, not the disclosure laws. Several companies are losing valuable patent protection for their products. "Eli Lilly began facing generic competition to its blockbuster antipsychotic Zyprexa in late 2011," ProPublica states. "Its antidepressant Cymbalta lost its patent at the end of 2013." Pfizer's patent on Lipitor, its top-selling cholesterol drug, expired in 2011.

Johnson and Johnson increased its speaker spending by 17 percent from 2011 to 2012. AstraZeneca's payments stayed the same after a previous decline around 2010.

ProPublica has been tracking publicly reported payments since 2010 as part of its Dollars for Docs project. Recently, ProPublica announced their plan to sell information they receive from FOIA requests and other "datasets that reflect substantial cleaning" to interested commercial users, academic researchers, and journalists. The website frames many of its stories around freely available data, but is now offering the information for a fee.

As we've written before, doctors clearly should not prescribe drugs based on their personal financial incentives. While that is the root of ProPublica's campaign, their Dollars for Docs project paints with far too broad a stroke. ProPublica's article suggests that the release of more and more payment information will discourage doctors from collaborating with industry. Is that a good thing? Once the Sunshine Act's website is public, will research relationships dry up as well?

Dollars for Docs makes for entertaining reading, but the website could harm fruitful and important collaborations under the false pretense that "transparency" is more important than medical advancements for patient health.